MAKING
LEARNING
FUN
Childcare Enrichment Program
YMCA OF GREATER LOUISVILLE
2011-12 SCHOOL YEAR REGISTRATION
ymcalouisville.org
We serve all JCPS students in grades
K-8. Transportation is available by
JCPS school bus between your
child’s school and CEP if needed.
The YMCA of Greater Louisville, in partnership with Jefferson
County Public Schools, offers the Childcare Enrichment
Program–where your child will laugh, learn and grow.
CHILDCARE ENRICHMENT PROGRAM
2011-2012 School Year
LEARN, GROW, THRIVE
ALWAYS HERE FOR YOU
The Y makes strengthening communities our cause. Through our
affordable child care programs we create a nurturing environment
to engage children and help them develop skills that will serve them
throughout their lives. We focus on ensuring that your child’s time
is spent creatively and constructively in the critical hours before and
after school and during school breaks.
Our before school program is from 7 am until the start of your child’s
school day. Our after school program is from the close of the school
day until 6 pm. Continuous care is also available 7 am - 6 pm during
school breaks, including in-service days and snow days. Spring Break,
Winter Break, and Summer Camps require separate registrations.
HELPING BUILD CONFIDENCE
With values of caring, honesty, respect and responsibility as our
guide, we work with you every day to ensure your children have fun
while helping them realize their potential. You can feel confident
knowing your child is safe and well cared for by our qualified staff.
Every staff member receives extensive hours of training and
professional development and is CPR and First Aid certified. We are
licensed child care and meet or exceed state licensing requirements.
BUILDING THE WHOLE CHILD
Your child will experience academic support, self-esteem building
and character development through activities designed to enrich,
strengthen and expand their learning. We offer homework
assistance through our Homework Club and maintain a strong
focus on literacy. We also encourage healthy eating habits, provide
opportunities for physical activity, and provide nutritious morning
and afternoon snacks daily.
CONNECTING WITH OUR FAMILIES
Our programs have an open door policy and parents are welcome
and encouraged to take part in your child’s day. Each site hosts
special family events throughout the year and our Parent Advisory
Committee offers parents the opportunity to give valuable feedback
towards program enhancements. Parent surveys will also be
distributed throughout the year, so we can receive your feedback
and continuously improve your experience.
SIGN UP TODAY!
WEEKLY RATES 2011-12
Childcare Enrichment Program
First Child
Each Additional
Program
Members
Y Facility
Member/
Partnership
Employee
Dependents
Program
Members
Y Facility
Member/
Partnership
Employee
Dependents
$47
$59
$73
$42
$54
$68
$37
$49
$63
$32
$44
$58
$39
$48
$60
$35
$44
$56
$31
$40
$52
$27
$36
$48
4- or 5-day
Before School Only
After School Only
Before & After School
1-, 2- or 3-day
Before School Only
After School Only
Before & After School
Registration
Fees Per Child
$30 per child
through August 4
$45 per child
starting August 5
In-service and snow days are included in total
number of days attended for the week. In-service and
snow day only rate is $22 per day, per child.
REGISTER TODAY
PAYMENT OPTIONS
Registration for the before and after school programs will continue
throughout the school year based on availability. All sites have minimum
and maximum enrollment numbers and registrations are processed
on a first-come, first-served basis. Completed registrations must be
received at least two business days prior to your child’s start date.
The 2011-12 school year program begins on Monday, August 15th.
Payments can be made by bank or credit card draft. Automatic draft
payments must be set up prior to the first day of attendance for
your child to attend our program. Drafts will occur each Wednesday
for the current week, unless they are otherwise scheduled through
our main office.
You can register one of the following ways:
• Online at ymcalouisville.org through August 4th
• Bring registration form and fee to your CEP Site Director
• Mail the registration form and fee to:
YMCA School-Age Child Care Services
2411 Bowman Avenue
Louisville, KY 40217
Mail must be post-marked one week prior to start date. Please
do not fax registration forms. If you have additional questions,
call 502 637 1575, or visit ymcalouisville.org.
ACCESS FOR ALL
At the Y, we believe everyone should have the opportunity to grow
up healthy, happy, confident and secure. That’s why we strive to
make our programs and services available to everyone, even if
they are unable to pay the full fee. Families can apply for financial
assistance with the cost of Y programs and membership. Assistance
is on an income-based sliding scale.
All sites are also eligible for 4-C and other third-party subsidy
reimbursements. Valid contracts must be on file with our office
prior to the program start date. Applicants who qualify for 4-C
or other child care subsidies will not be eligible for additional
assistance through the Y.
CEP is open to all JCPS students in grades K - 8. If your child’s school is not a CEP site listed below, transportation
is available between your child’s school and their CEP site. Visit our website or call 502 637 1575 for detailed
transportation information.
CEP SITES & LOCATIONS
Northeast Area
Southwest Area
Bowen Elementary, 1601 Roosevelt Avenue
Malcolm B. Chancey Jr. Elementary, 4301 Murphy Lane
Chenoweth Elementary, 3622 Brownsboro Road
Dunn Elementary, 2010 Rudy Lane
*Field Elementary, 120 Sacred Heart Lane
Greathouse Elementary, 2700 Browns Lane
Hite Elementary, 12408 Old Shelbyville Road
Lowe Elementary, 210 Oxfordshire Lane
Middletown Elementary, 218 North Madison Avenue
*Norton Elementary, 8101 Brownsboro Road
St. Matthews Elementary, 601 Browns Lane
*Joseph E. Stopher Elementary, 14417 Aiken Road
*Wilder Elementary, 1913 Herr Lane
Zachary Taylor Elementary, 9620 Westport Road
Cane Run Elementary, 3951 Cane Run Road
Conway Middle, 6300 Terry Road
Doss High School, 9601 St. Andrews Church Road
Fairdale Elementary, 10104 Mitchell Hill Road
Frederick Law Olmsted South Middle, 5650 Southern Parkway
Johnsontown Elementary, 7201 Johnsontown Road
Kerrick Elementary, 2210 Upper Hunters Trace
McFerran Elementary, 1900 South Seventh Street
Minors Lane Elementary, 8510 Minors Lane
Rutherford Elementary, 301 Southland Boulevard
Shacklette Elementary, 5310 Mercury Drive
Stuart Middle, 4601 Valley Station Road
Southeast Area
Audubon Traditional Elementary, 1051 Hess Lane
Bates Elementary, 7601 Bardstown Road
Bloom Elementary, 1627 Lucia Avenue
Blue Lick Elementary, 9801 Blue Lick Road
Cochrane Elementary, 2511 Tregaron Avenue
*James E. Farmer Elementary, 6405 Gellhaus Lane
Fern Creek Elementary, 8703 Ferndale Road
Goldsmith Lane Elementary, 3520 Goldsmith Lane
Hawthorne Elementary, 2301 Clarendon Avenue
Highland Middle, 1700 Norris Place
Jeffersontown Elementary, 3610 Cedarwood Way
Klondike Elementary, 3807 Klondike Lane
Laukhuf Elementary, 5100 Capewood Drive
Luhr Elementary, 6900 Fegenbush Lane
Rangeland Elementary, 1701 Rangeland Road
Smyrna Traditional Elementary, 6401 Outer Loop
Thomas Jefferson Middle, 1501 Rangeland Road
*Tully Elementary, 3300 College Drive
Watterson Elementary, 3900 Breckenridge Lane
*Wheeler Elementary, 5700 Cynthia Drive
Downtown Area
*Brandeis Elementary, 2817 W. Kentucky Street
Breckinridge-Franklin Elementary, 1351 Payne Street
Brown School, 546 South First Street
*Carter Traditional Elementary, 3600 Bohne Avenue
Coleridge-Taylor Elementary, 1115 West Chestnut Street
Foster Elementary, 4020 Garland Avenue
*Kennedy Montessori Elementary, 3800 Gibson Lane
Noe Middle, 121 West Lee Street
*Before and After School child care for 3- and 4-year olds enrolled in the host
school’s tuition-based Pre-K program will be provided at these sites only. No
full-day child care is available for preschoolers.
Please attach a recent wallet size photo and
immunization certificate for each child.
CHILDCARE ENRICHMENT PROGRAM 2011-12 SCHOOL YEAR REGISTRATION FORM
PLEASE PRINT LEGIBLY and include your registration fee. Register Online through August 4 at ymcalouisville.org.
th
Program start date
Email address
(To receive important program updates and registration information)
1 CHILD
st
First name
Race
Middle initial
African American/Black
Alaskan
Last name
Native Asian/Pacific Islander
Date of birth
Caucasian/White
Hispanic
/
Native American
/
Gender
To better serve your child, please indicate if he/she has been diagnosed with any of the following:
ADD/ADHD
Convulsions
Bleeding/Clotting Disorders
Autism
Aspergers
Fragile X
Cerebral Palsy
Bipolar Disorder
Down Syndrome
Chronic Health Problems
Asthma/Severe Allergies
Diabetes Heart defect/disease
Other
Yes
Participation
1-3 Days
Age
Tourettes
Rhett Syndrome
No
School Attending
Childcare Enrichment Program Site
Attendance
F
Medications/allergies
Physical conditions/special needs
Does this child have an IEP?
M
Other
4-5 Days
Before-School Care
Grade in School (2011-12)
After-School Care
Before- & After-School Care
In-Service Day Care
Snow Day Care
2nd CHILD
First name
Race
Middle initial
African American/Black
Alaskan
Last name
Native Asian/Pacific Islander
Date of birth
Caucasian/White
Physical conditions/special needs
Hispanic
/
Native American
/
Gender
Yes
Participation
1-3 Days
Tourettes
Rhett Syndrome
School Attending
4-5 Days
Before-School Care
Age
No
Childcare Enrichment Program Site
Attendance
F
Medications/allergies
To better serve your child, please indicate if he/she has been diagnosed with any of the following:
ADD/ADHD
Convulsions
Bleeding/Clotting Disorders
Autism
Aspergers
Fragile X
Cerebral Palsy
Bipolar Disorder
Down Syndrome
Chronic Health Problems
Asthma/Severe Allergies
Diabetes Heart defect/disease
Other
Does this child have an IEP?
M
Other
Grade in School (2011-12)
After-School Care
Before- & After-School Care
In-Service Day Care
Snow Day Care
1 PARENT/GUARDIAN
st
Name
Relationship to child
Address
Home phone
City
Cell phone
Date of birth
State
Work phone
/
/
/
/
Zip
Employer
2nd PARENT/GUARDIAN
Name
Relationship to child
Address
Home phone
City
Cell phone
Date of birth
State
Work phone
Zip
Employer
INSURANCE INFORMATION
Health insurance company
Policy number
Name of physician
Physician phone
PLEASE LIST ANY ADULT OTHER THAN THE ABOVE THAT MAY BE PICKING UP THIS CHILD OR THAT MAY BE CONTACTED IN AN EMERGENCY.
Anyone
picking up your child must be at least 18 years of age or older. A picture ID is required at pick-up.
.
Name
Relationship to child
Phone 1
Phone 2
Name
Relationship to child
Phone 1
Phone 2
The YMCA has permission for my children to be photographed and/or interviewed for promotional purposes
Yes
No
Yes
No
My child(ren) have permission to participate in basic health and fitness evaluations
Yes, I would like to make a charitable donation to The Spirit Campaign
$10
$25
$50
$100
Other/please contact me
Check here if either parent is
School partnership employee
YMCA employee
YMCA family facility member
Spirit recipient
YES! I would like to learn more about FREE or LOW-COST health insurance for my children and teens.
4-C recipient
You must choose one option below to process your registration. Drafts will occur each Wednesday for the current week unless otherwise scheduled through our main office.
I am currently on draft. Please use the account on file ending in ____________. Authorized account holder signature __________________________________________________________________________
I am authorizing a NEW bank draft from my checking account and I have attached a voided check.
I am authorizing a NEW credit card draft and I have provided all the information below:
Credit Card Type:
Visa
MasterCard
Discover
Name on card
Authorized cc signature
Card number
Expiration date
Billing street address
Billing zip code
I have the legal authority to sign up the child/children named on this form and to the best of my knowledge the information on this application form is complete and accurate. I understand that my application will not be processed
unless it includes the full fee or automatic draft authorization. I understand that the YMCA prohibits staff members from being alone with children they meet in YMCA programs outside of the YMCA. This includes but is not
limited to baby-sitting, tutoring, sleep-overs, etc. In the event I cannot be reached in an emergency, I hereby give permission to the director of the program or designee to secure emergency medical services, including transportation
and medical care. I also give permission for the attending physician to order injections, anesthesia or surgery for this child as named above. I understand that medical and accident insurance is the responsibility of the parent or
guardian. If my child(ren) attend Jefferson County Public Schools, by signing this form I am giving the YMCA permission to communicate and exchange information with JCPS for the purpose of providing and enhancing services
to my child(ren). There may also be times when JCPS or the YMCA may take photographs (or other digital images) of students participating in activities. Those images may appear in the YMCA’s or JCPS’s publications, including
electronic publications. By signing this form, I am giving permission to JCPS and the YMCA to use my child(s) image for the purposes listed above. I understand that this release may be revoked by me at any time by written request.
Signature
Date Signed